Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels swell and can become blocked with blood clots (thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger's disease usually first shows in the hands and feet and may expand to affect larger areas of your arms and legs.
Buerger's disease is rare in the United States, but is more common in the Middle East and Far East. Buerger's disease usually affects men between ages 20 and 40, though it's becoming more common in women.
Virtually everyone diagnosed with Buerger's disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger's disease. For those who don't quit, amputation of all or part of a limb may ultimately be necessary.
Symptoms
Buerger's disease symptoms include : -
Pain and weakness in your legs and feet or your arms and hands
Swelling in your feet and hands
Fingers and toes that turn pale when exposed to cold (Raynaud's phenomenon)
Open sores on your fingers and toes
When to see a doctor ?
See your doctor if you think you may have signs or symptoms of Buerger's disease.
Causes
It isn't clear what triggers Buerger's disease. The condition is caused by swelling in the arteries and veins of the arms and legs. The cells that cause the swelling - and eventually blood clots - form in the vessels leading to your hands and feet and block the blood flow to those parts of your body.
Reduced blood flow means that the skin tissue in your hands and feet doesn't get adequate oxygen and nutrients. This leads to the signs and symptoms of Buerger's disease, beginning with pain and weakness in your fingers and toes and spreading to other parts of your arms and legs.
Causes
It isn't clear what triggers Buerger's disease. The condition is caused by swelling in the arteries and veins of the arms and legs. The cells that cause the swelling - and eventually blood clots - form in the vessels leading to your hands and feet and block the blood flow to those parts of your body.
Reduced blood flow means that the skin tissue in your hands and feet doesn't get adequate oxygen and nutrients. This leads to the signs and symptoms of Buerger's disease, beginning with pain and weakness in your fingers and toes and spreading to other parts of your arms and legs.
Complications
If Buerger's disease worsens, blood flow to your arms and legs decreases. This is due to blockages that make it hard for blood to reach the tips of your fingers and toes. Tissues that don't receive blood don't get the oxygen and nutrients they need to survive. This can cause the skin and tissue on the ends of your fingers and toes to die (gangrene). Signs and symptoms of gangrene include black or blue skin, a loss of feeling in the affected finger or toe and a foul smell from the affected area. Gangrene is a serious condition that usually requires amputation of the affected finger or toe.
Tests and diagnosis
Your doctor will ask you about your signs and symptoms. No tests can confirm whether you have Buerger's disease. Instead, your doctor will likely order tests to rule out other more common conditions. These tests may include : -
Blood tests : -
Blood tests to look for certain substances can rule out other conditions that may cause similar signs and symptoms. For instance, blood tests can help rule out scleroderma, lupus, blood clotting disorders and diabetes, along with other diseases and conditions.
The Allen's test : -
Your doctor may conduct a simple test called the Allen's test to check blood flow through the arteries carrying blood to your hands. In the Allen's test, you make a tight fist, which forces the blood out of your hand. Your doctor presses on the arteries at each side of your wrist to slow the flow of blood back into your hand, making your hand lose its normal color. Next, you open your hand and your doctor releases the pressure on one artery then the other. How quickly the color returns to your hand may give a general indication about the health of your arteries. Slow blood flow into your hand may indicate a problem, such as Buerger's disease.
Angiogram : -
An angiogram, also called an arteriogram, helps doctors see the condition of your arteries. Doctors inject dye into an artery and then take X-rays or other types of images. Images show any blockages in the artery. Your doctor may order arteriograms be performed on both of your arms and your legs - even if you don't have signs and symptoms of Buerger's disease in all of your limbs. Buerger's disease almost always affects more than one limb, so even though you may not have signs and symptoms in your other limbs, this test may detect early signs of vessel damage.
Treatments and drugs
No treatments can cure Buerger's disease. Instead, your doctor may try various treatment approaches to reduce any signs and symptoms you have. Options include : -
Counseling or medications to help you stop smoking and stop the swelling in your blood vessels
Medications to improve blood flow or to dissolve blood clots
Surgery to cut the nerves in the affected area (surgical sympathectomy) to control pain
Amputation, if infection or gangrene occurs
It is essential to stop smoking.
Keep the hands and feet warm and protected from trauma and infection.
Although no single treatment is considered definitive, consideration of an intravenous infusion of Iloprost (a medication that helps relax blood vessel walls and reduce clotting), sympathectomy (ablation of the nerves causing blood vessel constriction), and removal of gangrenous tissue may be necessary.
There is little evidence that systemic steroids or anticoagulants are helpful.
Lifestyle and home remedies
Take care of your fingers and toes if you have Buerger's disease. Check the skin on your arms and legs daily for cuts and scrapes, keeping in mind that if you've lost feeling to a finger or toe, you may not have felt, for example, a cut when it happened.
Low blood flow to your extremities means your body can't resist infection as easily. Small cuts and scrapes can easily turn into serious infections. Clean any cuts with water and cover them with a clean bandage. Keep an eye on any cuts or scrapes to make sure they're healing. If they get worse or heal slowly, see your doctor promptly.
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